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Sustiva/Combivir combo and
Sep 6, 2002

Hello, I have a question with respect to what is referred to as a "blip". I was diagnosed approximately 2 years ago. At that time my vl was 89,900, my CD4 count was 450. Upon my doctor's advice I started treatment combo of Sustiva and Comibivir. I thankfully became "undetectable-<50" within 3 months of starting treatment. To this point I have remained undetectable up to the last round of tests, July 2002. To my horror, my vl had gone from undetectable to 142, my CD4 cound dropped from 778 to 650. I was absolutely shocked as I have not missed any meds at any point. I regularly excerise, eat properly, do not take non prescription drugs and do not take alcohol in any form. My health specialist has assured me that this is an anomally and is what is referred to as a "blip". He told me that this does occur in anywhere from 1 in 4 to 1 in 5 patients. He also assured me that it would be highly improbable that this would mean that I have started down the road to resistance to my current med. combo of sustiva/comibivir. New blood work was completed and I am presently waiting on the results and the wait is totally consuming me with worry and heartache. I have read your previous response to the question regarding a "blip" but no mention was made of the medication being taken. Please, what in your estimation is the likelihood of my last vl count of 142 being an indication of impending resistance to the sustiva/combivir combo which I am currently on? Although I do trust my specialists' assessment that this is mere a "blip" I would very much appreciate your assessment respecting this totally unexpected increase in my viral load. Thank you for your expert opinion. I really need some additional reassurance right now for some peace of mind.

Positive in Canada!

Response from Dr. Little

I am going to concur with your phsycian completely. Although I would like to say I am certain this is not resistance, that is impossible to do - there are exceptions to every rule. What I can say is that low level relapses in viral loads (i.e. blips) less than 200 copies have been well described in fully suppressed patients and have not been found to be associated with impending virological failure or drug resistance. If you have been adherent with your medications, I would try not to be too anxious and would expect that your next test will show you to be undetectable again.

Resistence for 20 years?

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